Chief Medical Officer
Minneapolis, MN, USA | Leading Healthcare - Hospitals Company
Industry:Healthcare - Hospitals
Job Description:89 people have viewed this job
The Chief Medical Officer is responsible for three major areas: 1) overseeing the clinical teams that operate within Clinical Operations and establishing a clear strategy and direction for their work; 2) in concert with the Clinical Market Performance team establish effective external relationships with health system physician leaders focused on establishing and executing against market population health, risk, and quality targets, and 3) direct oversight and leadership of risk adjustment, and quality/Stars teams and goals.
Establish the strategy for population management for each line of business in each market. In addition, establish the tenets of our overarching population health, risk adjustment, and quality/Stars strategies at Leading Healthcare - Hospitals Company.
Represent Leading Healthcare - Hospitals Company externally at selected conferences, in key professional bodies, with Care Partner clinical and other executive leadership, with media and in other venues.
Establish the strategy and oversee the medical functions of the utilization review and quality assurance—you will not be responsible for operationalizing the technology, teams, and reporting for these functions.
Build and manage a team of clinical experts to ensure effective population health management and Care Partner interactions in collaboration with the Clinical Market Performance team.
Lead Leading Healthcare - Hospitals Company’s clinical staff directly or through dotted line relationships; recruit and assist in the recruitment of key clinical staff.
Support population health staff to ensure timely and consistent responses to members and Care Partners.
Act as lead business and clinical liaison to network providers and facilities to support the effective execution of population health, risk adjustment, and quality/Stars programs
Provide oversight and business direction for the following activities, including but not limited to:
Pharmacy and Therapeutics management
Quality Management and Programs
Risk Accounting Programs
Appeals and Grievances Review
Network Management and Evolution
Market-level clinical management and program development
Provides clinical consultation to departments outside Health Optimization, including
Care Partner Integration
Participate the establishment of path-to-value activities with Care Partners leading to value based payment models.
Oversee clinical teams and vendors in partnership with the Population Health Operations team to ensure timeliness in meeting all required Federal and State turnaround time on clinical decision making, including but not limited to: Decision reviews that must occur within 6 hours on occasion as demanded by state and federal guidelines. Ability to participate in second review of group decision must often occur in 24 hours
Periodically consults with other practitioners in the field.
This position has supervisory responsibilities for the all Medical Directors and the Vice President and of Stars, Quality, and Risk Adjustment.
EDUCATION, TRAINING AND PROFESSIONAL EXPERIENCE
Bachelor’s degree required; Master of Public Health (MPH), Master of Health Administration (MHA) or Master of Business Administration (MBA) is preferred
Three or more years of experience in Clinical Practice and/or Health Care Industry is required.
Three or more years of direct clinical care in private and/or academic practice that includes oversight of direct patient care is required.
Post-graduate experience in direct patient care is required.
Previous leadership experience in a clinical oversight role is required.
Previous Medicare and/or Commercial insurance industry experience preferred.
Ability to meet all required Federal and State turnaround time on clinical decision making, including but not limited to; decision reviews that must occur within 6 hours on occasion as demanded by state and federal guidelines.
Ability to participate in second review of group decision must often occur within 24 hours
Demonstrated knowledge of established medical management and clinical services.
Strong interpersonal and communication skills.
Commitment to carrying out professional responsibilities and an adherence to ethical principles.
Most work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.